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Gold-tier hospital insurance covers all 38 treatments outlined by the Australian government. This includes treatments like joint replacements, pregnancy, insulin pumps, as well as all services covered by Silver-tier policies. See below for a comprehensive list.
There are 4 tiers of private health insurance; basic, bronze, silver and gold. As you might assume, each level refers to how many treatments are covered with basic being at the thinner end of coverage and gold being the most comprehensive cover available.
Clinical Category | Gold | Silver | Bronze | Basic |
---|---|---|---|---|
Rehabilitation | R | R | R | |
Hospital psychiatric services | R | R | R | |
Palliative Care | R | R | R | |
Brain and nervous system | O (R) | |||
Eye (not cataracts) | O (R) | |||
Ear, nose and throat | O (R) | |||
Tonsils, adenoids and grommets | O (R) | |||
Bone, joint and muscle | O (R) | |||
Joint reconstructions | O (R) | |||
Kidney and bladder | O (R) | |||
Male reproductive system | O (R) | |||
Digestive system | O (R) | |||
Hernia and appendix | O (R) | |||
Gastrointestinal endoscopy | O (R) | |||
Gynaecology | O (R) | |||
Miscarriage and termination of pregnancy | O (R) | |||
Chemotherapy, radiotherapy and immunotherapy for cancer | O (R) | |||
Pain Management | O (R) | |||
Skin | O (R) | |||
Breast surgery (medically necessary) | O (R) | |||
Diabetes management (excluding insulin pumps) | O (R) | |||
Heart and vascular system | O | O (R) | ||
Lung and chest | O | O (R) | ||
Blood | O | O (R) | ||
Back, neck and spine | O | O (R) | ||
Plastic and reconstructive surgery (medically necessary) | O | O (R) | ||
Dental Sugery | O | O (R) | ||
Podiatric surgery (provided by a registered podiatric surgeon) | O | O (R) | ||
Implantation of hearing devices | O | O (R) | ||
Cataracts | O | O | O (R) | |
Joint replacements | O | O | O (R) | |
Dialysis for chronic kidney failure | O | O | O (R) | |
Pregnancy and birth | O | O | O (R) | |
Assisted reproductive services | O | O | O (R) | |
Weight loss surgery | O | O | O (R) | |
Insulin pumps | O | O | O (R) | |
Pain management with device | O | O | O (R) | |
Sleep studies | O | O | O (R) |
Indicates the clinical category is a minimum requirement of the product tier. | |
(R) | Restricted cover permitted: insurers are allowed to offer cover for this clinical category on a restricted basis. A restricted benefit means you are partially covered for hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital so you should check with your insurer and hospital for details. | O | Optional for the insurer to include: insurers may choose to offer these as additional clinical categories. |
The cost of health insurance will vary based on your state, age, income and more. It'll also change based on whether you're buying hospital cover on its own or with an extras policy.
To give you an idea of costs, we've gotten the average monthly cost for gold hospital cover and broken it down per state. These costs are based on a single individual with less than $97,000 income with a $750 excess.
Average monthly premium | |
---|---|
NSW | $245.21 |
QLD | $260.03 |
VIC | $268.88 |
TAS | $236.09 |
SA | $223.93 |
NT | $149.55 |
WA | $210.56 |
These average prices are updated as of October 2024, in line with Finder's database of health insurance policies.
Waiting periods refer to the time between when you take out a policy and the time when you're able to claim on that policy. This is relevant to those who are taking out a policy for the first time and those who have increased their cover level, say, from silver to gold.
The government sets the maximum waiting periods for all services. They are:
In some special circumstances, you can access mental health treatment in a hospital without having to serve the waiting period.
For extras policies, insurers can set their own waiting periods.
"I got Medibank Gold Hospital health insurance so I was covered for obstetrics. Providing my healthcare details to the private hospital was really easy and Medibank called me via their concierge service as I was approaching my due date to answer any questions I might have. Best of all, my baby was covered under the same policy from birth, which meant that the unexpected ambulance transfer across the city and specialist tests for him were also covered. Overall, it was a good experience and I plan to stay with Medibank for any subsequent pregnancies. "
If you're starting a family and want to have access to a private room during childbirth, you're going to want a gold hospital policy. Benefits only available on gold policies include:
Getting older means you're more susceptible to certain conditions – gold coverage includes a range of treatments that are especially useful to older Australians. A few examples that are helpful for seniors include:
There are many other treatments only covered under gold-tier health insurance policies which may be essential for some people. Here are a few gold treatments that could apply to you:
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